title: Delayed primary versus late secondary wound closure in the treatment of postsurgical sternum osteomyelitis.
abstract: Sternal osteomyelitis and poststernotomy mediastinitis is a severe and life-threatening complication after the cardiac surgery. The incidence ranges up to 3% with a mortality rate up to 29%. In addition, postoperative infections after sternotomy are associated with prolonged hospital stay, increased healthcare costs and impaired quality of patient life, representing an economic and social burden. The emergence of increasing antimicrobial resistant bacteria augments the importance of postsurgical infections since the antimicrobial choices are becoming limited. Furthermore, the incidence of infection is an indicator for the quality of patient care in the international benchmark studies. Although several therapy strategies are nowadays present in clinical practice, there is a lack of evidence-based surgical consensus for treatment of this surgical complication. In most cases the poststernotomy mediastinitis involves surgical revision with debridement, open dressing and/or vacuum-assisted therapy. After the granulation tissue on open chest wound is achieved, secondary closure and/or reconstruction with vascularized soft tissue flaps, such as omentum or pectoral muscle is performed. It seems there is a need for more effective surgical treatment of poststernotomy wound infections, which may address the prolonged hospitalization and reduce the number of surgical interventions and with this also the perioperative morbidity. In light of this we propose a randomized study comparing new delayed primary closure of the sternum to the secondary vacuum-assisted closure.
authors.affiliation: Department of Cardiovascular Surgery, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland. denis.berdajs@chuv.ch
authors.forename: Denis A
authors.initials: DA
authors.lastname: Berdajs
authors.forename: Andrej
authors.initials: A
authors.lastname: Trampuz
authors.forename: Enrico
authors.initials: E
authors.lastname: Ferrari
authors.forename: Patrick
authors.initials: P
authors.lastname: Ruchat
authors.forename: Michel
authors.initials: M
authors.lastname: Hurni
authors.forename: Ludwig K
authors.initials: LK
authors.lastname: von Segesser
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003646:Debridement; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D008480:Mediastinitis / Q000191:economics / Q000382:microbiology / Q000628:therapy*; D054843:Negative-Pressure Wound Therapy / Q000009:adverse effects / Q000191:economics; D010019:Osteomyelitis / Q000191:economics / Q000382:microbiology / Q000628:therapy*; D010027:Osteotomy; D012086:Reoperation; D012107:Research Design; D056346:Sternotomy / Q000009:adverse effects* / Q000191:economics; D013524:Surgical Flaps / Q000009:adverse effects; D013557:Switzerland; D013997:Time Factors; D016896:Treatment Outcome; D058106:Wound Closure Techniques / Q000009:adverse effects / Q000191:economics
chemical_list: D000900:Anti-Bacterial Agents